Written by

Lisa Bernard-Kuhn

The Cincinnati Enquirer

The nation’s largest health care accreditation group told The Cincinnati Enquirer in an exclusive interview that it’s reconsidering its pain management standards — which many physicians argue helped fuel the painkiller explosion.

“We agree that this is a public health crisis right now,” said Dr. Daniel J. Castillo, director of the Joint Commission’s Healthcare Quality Evaluation. “The standard is to ask if (patients) have pain, and if they do, that it is either treated or they are referred for treating. There probably have been cases of misunderstanding. Something I’ve been working hard to do is to clear up some of those things.”

In the late 1990s, the U.S. Department of Veterans Affairs first crafted a set of guidelines for assessing and treating patients with acute pain, which is considered pain that lasts for less than 30 days. Then, in 2001, the Joint Commission — powerful among health systems because they need its accreditation — issued its own guidelines requiring hospitals and doctors to screen, assess and treat all patients for pain.

Pain “was sort of adopted as a fifth vital sign,” said Dr. Humam Akbik, director of Mercy Health’s Pain Management Center, who worked as a pain specialist at the Boston VA in the 1990s. “But unfortunately, when the Joint Commission adopted this and made it mandatory, the concept was broadened to include chronic pain. That’s where the problem started, and that’s where the misuse (of opioids) became rampant.”

The commission also gave Purdue Pharma, maker of the painkiller OxyContin, exclusive access to health systems to distribute pain education materials that later were deemed misleading, resulting in a $600 million fine against Purdue after OxyContin sales had boomed and reports of abuse of the drug emerged across the country.

The U.S. Senate Finance Committee has begun an investigation of the relationship between Purdue and the Joint Commission and of pharmaceutical companies’ roles in the nation’s opioid crisis.

Castillo said the Joint Commission is now leading an effort to bring “stakeholders together to begin modifying or updating our pain management standards.”

“What we’re trying to do now is make sure we fully understand the problem,” he said.